=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275701427
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEWCOMER EYE CARE I P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2008
-----------------------------------------------------
Last Update Date | 11/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4564 S SUNCOAST BLVD
-----------------------------------------------------
City | HOMOSASSA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34446-1103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-628-3029
-----------------------------------------------------
Fax | 352-628-6377
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4564 S SUNCOAST BLVD
-----------------------------------------------------
City | HOMOSASSA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34446-1103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-628-3029
-----------------------------------------------------
Fax | 352-628-6377
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANNEMARIE DARTS NEWCOMER
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 352-628-3029
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | OPC2324
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC2324
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------